Measuring severity of behavior: a revision of Part II of the Adaptive Behavior Scale

This study was designed to: (a) assess the degree to which rehabilitation staff rate the severity of maladaptive behaviors on Part II of the AAMD Adaptive Behavior Scale (ABS) and, on the basis of the obtained rating, (b) develop a socially validated revision of the scoring system to allow more accurate classification of mentally retarded individuals as having mild, moderate, or severe behavior problems. On the basis of the modal ratings obtained from various service agencies for "occasionally" and "frequently" on Part II of the ABS, we constructed a revised scoring system. Preliminary use of the scoring system suggests satisfactory agreement between "severity profile" scores and subjective ratings of individuals classified by service agencies as demonstrating mild, moderate, or severe behavior problems.     

Application of validated mapping algorithms between generic PedsQL scores and utility values to individuals with sickle cell disease

Quality of Life Research - There is a paucity of empirically estimated health state utility (HSU) values to estimate health-related quality of life among individuals with sickle cell disease (SCD)....     

Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses

The ongoing global pandemic caused by coronavirus disease has once again demonstrated the role of the family Coronaviridae in causing human disease outbreaks. Because severe acute respiratory syndrome coronavirus 2 was first detected in December 2019, information on its tropism, host range, and clinical manifestations in animals is limited. Given the limited information, data from other coronaviruses might be useful for informing scientific inquiry, risk assessment, and decision-making. We reviewed endemic and emerging infections of alphacoronaviruses and betacoronaviruses in wildlife, livestock, and companion animals and provide information on the receptor use, known hosts, and clinical signs associated with each host for 15 coronaviruses detected in humans and animals. This information can be used to guide implementation of a One Health approach that involves human health, animal health, environmental, and other relevant partners in developing strategies for preparedness, response, and control to current and future coronavirus disease threats.     

Letermovir in lung transplant recipients with cytomegalovirus infection: A retrospective observational study

Letermovir is a new antiviral drug approved for the prophylaxis of CMV infection in allogeneic stem cell transplants. The aim of the study was to assess the therapeutic efficacy of letermovir in difficult to treat CMV infections in lung transplant recipients. All lung transplant recipients between March 2018 and August 2020, who have been treated with letermovir for ganciclovir-resistant or refractory CMV infection were included in the study and analysed retrospectively. In total, 28 patients were identified. CMV disease was present in 15 patients (53.6%). In 23 patients (82.1%), rapid response was noticed, and CMV-viral load could be significantly decreased (>1 log₁₀) after a median of 17 [14–27] days and cleared subsequently in all of these patients. Five patients (17.9%) were classified as non-responder. Thereof, development of a mutation of the CMV UL56 terminase (UL-56-Gen: C325Y) conferring letermovir resistance could be observed in three patients (60%). Common side effects were mild and mostly of gastrointestinal nature. Mild adjustments of the immunosuppressive drugs were mandatory upon treatment initiation with letermovir. In addition to other interventions, letermovir was effective in difficult to treat CMV infections in lung transplant recipients. However, in patients with treatment failure mutation conferring letermovir, resistance should be taken into account.     

A phase II study of ifosfamide in endometrial cancer

Around 32% of all patients with endometrial carcinoma relapse after primary therapy. The outlook for these patients is poor. Ifosfamide (IFX) has activity in a number of gynaecological malignancies and was selected for evaluation in this disease. The aims of this study were to assess the activity and toxicity of IFX in recurrent endometrial carcinoma no longer amenable to radical local treatment. In all, 16 evaluable patients with symptomatic advanced metastatic or recurrent disease entered a phase II study of this drug. Patients received IFX (5 g/m²) as a 24-h infusion, with mesna (8 g/m²) given during and for 12 h following IFX to prevent urothelial toxicity. Treatment was repeated every 21 days. Two patients showed evidence of response [one complete response (CR) of 3 months and one partial response (PR) lasting 5 months]. Most patients experienced nausea and vomiting, and WHO grade 3/4 alopecia invariably occurred after two or more cycles. Four patients developed severe (grade 3/4) IFX/mesna CNS toxicity, and four other patients had mild (grade 1/2) CNS toxicity. Significant myelosuppression was seen in 3/41 cycles. Haematuria was uncommon and invariably mild. There were two toxic deaths (one due to grade 4 CNS toxicity and one due to septicaemia). IFX has activity in endometrial carcinoma, but responses are of limited duration and toxicity is considerable.Presented at the Satellite Symposium Ifosfamide in Gynecological Tumors of the 5th European Conference on Clinical Oncology and Cancer Nursing, London, September 3–7, 1989     

Social aspects of AIDS-related stigma in rural Uganda

In the process of collecting sexual behaviour data through in-depth interviews, 24 respondents offered information on stigma related to HIV-1 infection. Observations of social relations in public places and families of infected individuals were made. The findings suggest that although HIV/AIDS-related stigma has had adverse effects on treatment seeking behaviour of PWAs and coping mechanisms of their families, a more tolerant attitude is starting to emerge in this area. Probably, due to improvements in counselling services and home care schemes for those with AIDS. This supports the call for increased investments in counselling and community development aimed at caring for people with AIDS (PWAs).     

Systemic steroid prophylaxis for cataract surgery in patients with posterior uveitis

Cataract remains difficult to manage in patients with uveitis affecting the posterior segment of the eye due to the high risk of postoperative complications, especially cystoid macular oedema, even in eyes in which inflammation has been completely suppressed preoperatively. A standard regimen of preoperative and perioperative systemic steroid prophylaxis was introduced into the uveitis clinic in order to prevent uveitis-related cystoid macular oedema in the postoperative period. The aim of this study was to assess if this policy resulted in an improvement in the visual recovery. Data from a single consecutive clinical series of 30 extracapsular cataract extraction procedures performed in 24 patients with posterior uveitis were collected retrospectively. Nineteen procedures were performed before and 11 after the introduction of the regimen of steroid prophylaxis. Success was graded according to the Snellen acuity at six months, the number of lines improvement in visual acuity by six months and the time from the operation date for acuity to recover to its best postoperative level. The median visual acuity after six months was 20/30 in the prophylaxis group compared with 20/80 in the controls (p = 0.052), representing a median improvement of five lines in the prophylaxis group and three lines in the controls (not significant). The eyes receiving prophylaxis achieved their best acuity in 1.8 months (median) compared with 5.9 months for the control group (p<0.01). This was not attributable to the longer period of follow-up in the control group and was independent of IOL implantation or the influence of any individual postoperative complication. When pseudophakic eyes were considered in isolation, the median acuity at six months was also better in the prophylaxis group (p = 0.023). The results suggest that preoperative systemic steroid prophylaxis may benefit the patient by hastening postoperative visual recovery independently of IOL implantation.     

Risk assessment of microcystin in dietary Aphanizomenon flos-aquae.

Aphanizomenon flos-aquae, a cyanobacterium that is marketed as a health food supplement, is harvested from natural blooms in Klamath Lake (Oregon) that are occasionally contaminated by Microcystis spp. Regulatory agencies in several countries are developing regulations to control the amount of microcystin in drinking water and other products, including products produced from A. flos-aquae. Regulation of microcystin (MC), a toxin produced by Microcystis spp. that is potentially present in natural culture of A. flos-aquae, should be based on studies in which a test species is exposed to the natural mixture of these cyanobacteria. A 1984 feeding trial to determine the effects of high dietary levels of A. flos-aquae on reproduction and development of mice is reanalyzed in light of recent analyses for microcystin-LR (MCLR) in the diets of those mice. Young adult mice consuming up to 333 microg MCLR/kg body weight (bw)/day exhibited no adverse effects on growth and reproduction, fetal development, and survival and organ weights of neonates. Based on a NOAEL of 333 microg MCLR/kg bw/day, a safety factor of 1000, consumption of 2 g/day of A. flos-aquae by a 60-kg adult, the safe level of MCLR as a contaminant of A. flos-aquae products is calculated to be 10.0 microg MCLR/g.